Craziness 2
Pattern of excessive emotionality and attention seeking
Manipulates others through self-dramatization,
theatricality, and exaggerated expression of emotion
Speech may be excessively impressionistic and lacking indetail
Inappropriate and sexually seductive or provocative
behavior
May use physical appearance to draw attention to
themselves
Sudden emotional shifts and emotional lability
Highly suggestible
What is Histrionic Personality Disorder?
Possible Signs and Symptoms of what eating disorder?
Terror of gaining weight
Preoccupation with thoughts of food
View of self as fat even when emaciated
Peculiar handling of food:
• Cutting food into small bits
• Pushing pieces of food around plate
Possible development of rigorous exercise regimen
Possible self-induced vomiting; use of laxatives and diuretics
Cognitive distortions: individual judges own self-worth by weight
Controls eating to feel powerful to overcome feelings of helplessness
What is anorexia nervosa?
A patient with bulimia nervosa has become dehydrated from self-induced vomiting. This is most likely to result in:
A. Hyperchloremia.
B. Hypokalemia.
C. Tachycardia.
D. Parotid gland atrophy.
B. Hypokalemia.
Is a serious change in mental abilities. It results in confused thinking and a lack of awareness of someone's surroundings. The disorder usually comes on fast — within hours or a few days.
Is always secondary to another condition
Possible causes: medical conditions, substance use (intoxication and withdrawal), and medication or toxin exposure
What is Delirium?
Hypersensitive to criticism or rejection
Avoid situations requiring socialization
May view themselves as socially inept, personally
unappealing or inferior to others
Reluctant to take personal risks for fear of
embarrassment
Feelings of inadequacy lead to inhibition in new
interpersonal relationships
What is Avoidant Personality Disorder
Possible Signs and Symptoms of what eating disorder?
Binge eating behaviors
Compensatory behavior after bingeing
History of anorexia nervosa
Depressive signs and symptoms
Problems with:
• Interpersonal relationships
• Self-concept
• Impulsive behaviors; reports feeling “out of control” at times
Increased levels of anxiety and compulsivity
Possible co-morbid substance use disorder
What is Bulimia Nervosa?
Which of the following is an example of all-or-nothing thinking, which is a frequent cognitive distortion of patients with an ED?
A. “If I allow myself to gain weight, I’ll be huge.”
B. “I’m unpopular because I’m fat.”
C. “When I’m thin, I’m powerful.”
D. “When people say I look better, they’re really
thinking I look fat.”
A. “If I allow myself to gain weight, I’ll be huge.”
In caring for a patient with late AD (Alzheimer’s
Disease), which nursing diagnosis demands the nurse’s highest priority?
A. Risk for injury
B. Self-care deficit
C. Chronic low self-esteem
D. Impaired verbal communication
A. Risk for injury
Gale’s medical history (from previous admissions) indicates a diagnosis of depressive disorder and BPD. Based on these diagnoses, which of the following will be your best initial intervention as you begin your shift?
A. Allow Gale to act out her frustrations since she is newly admitted.
B. Immediately set strict limits so that Gale knows who is in control.
C. Instruct a mental health technician to monitor Gale on a 15-minute basis.
D. Introduce yourself, and let Gale know that you will be her nurse during your shift.
D. Introduce yourself, and let Gale know that you will be her nurse during your shift.
This response communicates caring and professionalism to Gale and possibly opens further channels of communication.
Which of the following is least likely to contribute to building an effective therapeutic alliance between the nurse and a patient with anorexia?
A. Establishing disciplined eating through the nurse’s authoritarian approach with the patient
B. Avoiding the stance of a parental role to foster a sense of empowerment
C. Offering a highly structured approach in treating patients who are severely underweight
D. Contracting with the outpatient person about treatment terms
A. Establishing disciplined eating through the nurse’s
authoritarian approach with the patient
Mrs. Chauncey, 80 years old, is taking a selective serotonin reuptake inhibitor (SSRI) and Tylenol PM daily plus other medications. She has multiple, vague somatic complaints. This morning she complains of a “stomachache” and “gas.”
What is your best initial nursing response?
A. Tell her to increase her water intake.
B. Perform a digital rectal examination for impaction.
C. Document the complaint of abdominal pain.
D. Assess bowel sounds in all four quadrants.
D. Assessing bowel sounds
Four prescription drugs currently approved by
the FDA for individuals with Alzheimer’s disease
Cholinesterase inhibitors
• Galantamine hydrobromide (Razadyne)
• Rivastigmine tartrate (Exelon)
• Donepezil hydrochloride (Aricept)
Memantine hydrochloride (Namenda)
Gale tells another nurse on the unit, “You are the only decent person here. You really care, and my nurse is really cold.” This nurse is new to the unit and does not know how to answer. What would be your best response to Gale if you were in this position?
A. “You seem concerned about how you are being treated here on this unit.”
B. “You have just not learned to trust people; your nurse is a good person.”
C. “Your personality disorder is causing you to be angry and distrustful.”
D. “You need to understand that all the staff here are very caring.”
A. “You seem concerned about how you are being treated on this unit.”
This response gives the patient an opportunity to respond and communicates that you are listening.
Variant of compulsive overeating
Similar pattern to BN but without compensatory
mechanisms such as self-induced vomiting
Usually co-occurring with psychiatric disorders
such as bipolar disorder, depressive disorder,
anxiety disorder, and, to a lesser extent,
substance use disorders
In approximately 50% of a sample of obese
binge eaters, no attempt to restrict dietary intake
occurred before bingeing, unlike with BN
What is Binge Eating Disorder (BED)
Mrs. Chauncey, 80 years of age, complains of stomach pain and is now mute and staring out of her window. She is refusing food. Which of the following interventions are appropriate? (Select all that apply.)
A. Give her privacy, and close her door.
B. Speak with her, although she may not answer.
C. Continue to offer her food and fluids.
D. Regularly assess vital signs and skin turgor.
B. Speak with her, although she may not answer.
C. Continue to offer her food and fluids.
D. Regularly assess vital signs and skin turgor.
Nursing staff that care for patients who are cognitively impaired can develop burnout. Strategies to avoid the development of burnout include:
A. Setting realistic patient goals.
B. Insulating self from emotional involvement with patients.
C. Sedating patients to promote rest and minimize catastrophic episodes.
D. Encouraging the family to permit the use of restraints to promote patient safety.
A. Setting realistic patient goals.
Systems training for emotional predictability and problem solving (STEPPS) is most likely to prove helpful to a patient with which personality disorder?
A. Obsessive-compulsive PD
B. Schizotypal PD
C. Borderline PD
D. Antisocial PD
C. Borderline PD
What four Medication should not be offered as the sole
treatment for BED (Binge Eating Disorder)
Fluoxetine
Lisdexamfetamine (Vyvanse)
Topiramate (Topamax)
Dasotraline
Mrs. Chauncey receives a visit from her priest. He runs out of her room and then pulls the nurse assistant back into her room. Mrs. Chauncey is cutting her left wrist (superficially) with the 5 x 7 glass from a framed photo of a grandchild. She is taken to the emergency department, where her wrist is bandaged. Her daughter and son-in-law are notified. As her nurse, which of the following statements helps clarify what has taken place?
A. “Don’t worry, I think your mom is just confused.”
B. “Your mom has been more withdrawn over the last few days.”
C. “I am very concerned that your mom is suicidal.”
D. “When your mom’s priest arrived, he found her cutting her wrist with the glass from a framed photo.”
D. “When your mom’s priest arrived, he found her cutting her wrist with the glass from a framed photo.”
Psychobiological agents showing promise for the treatment of cognitive impairment associated with AD (Alzheimer’s disease) include:
A. Cholinesterase inhibitors
B. Herbals, including ginkgo biloba
C. SSRIs and trazodone
D. Benzodiazepines and buspirone
A. Cholinesterase inhibitors